Department of Neurology and Neurosurgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Semin Neurol. 2010 Nov;30(5):545-54. doi: 10.1055/s-0030-1268862. Epub 2011 Jan 4.
Subarachnoid hemorrhage (SAH) accounts for ~5% of strokes, but causes high rates of morbidity and mortality and occurs at a relatively young age. The rupture of an intracranial aneurysm is the leading cause of nontraumatic SAH and will be the subject of this review. Rebleeding remains the most imminent danger until the aneurysm is secured (i.e., excluded from the cerebral circulation). Therefore, prompt aneurysm treatment is crucial to minimize this risk. Endovascular occlusion of the aneurysm with coils has been shown to be associated with better short- and long-term outcomes than surgical clipping in select patients. Yet, angiographic surveillance is necessary after endovascular treatment and retreatment with additional coiling may be required. Delayed cerebral vasospasm is the leading cause of brain damage once the aneurysm has been treated. Hemodynamic augmentation therapy remains the mainstay of medical treatment, but various agents are being tested as means to prevent or ameliorate vasospasm, including magnesium sulfate, statins, and an endothelin antagonist. Medically refractory vasospasm demands angioplasty of the affected vessel or intraarterial infusion of vasodilators. In this review, the authors provide an overview of the diagnosis and management of aneurysmal SAH with an emphasis on these main topics.
蛛网膜下腔出血 (SAH) 约占中风的 5%，但其发病率和死亡率较高，且发病年龄相对较小。颅内动脉瘤破裂是导致非创伤性 SAH 的主要原因，也是本综述的主题。再出血仍然是最紧迫的危险，直到动脉瘤得到固定（即从脑循环中排除）。因此，及时治疗动脉瘤对于最大限度地降低这种风险至关重要。在一些患者中，与手术夹闭相比，血管内用线圈闭塞动脉瘤与更好的短期和长期结果相关。然而，血管内治疗后需要进行血管造影监测，可能需要额外的线圈再治疗。一旦动脉瘤得到治疗，迟发性脑血管痉挛是导致脑损伤的主要原因。血流动力学增强治疗仍然是主要的药物治疗方法，但正在测试各种药物作为预防或减轻血管痉挛的手段，包括硫酸镁、他汀类药物和内皮素拮抗剂。药物难治性血管痉挛需要对受影响的血管进行血管成形术或动脉内输注血管扩张剂。在本综述中，作者提供了对动脉瘤性蛛网膜下腔出血的诊断和治疗的概述，重点介绍了这些主要内容。
